Systemic Embolism From Aortic Arch Thrombus Following Warfarin Discontinuation: A Case Report

We present the case of a 40-year-old female with a previous diagnosis of unprovoked deep vein thrombosis (DVT), who had been on long-term warfarin therapy but discontinued it one month before presentation. She arrived at the emergency department following two episodes of transient loss of consciousness at work, raising concerns for a possible cerebrovascular event. Further evaluation revealed evidence of systemic embolization, as she developed acute basilar artery thrombosis and left upper limb ischemia findings consistent with multiple embolic events. Computed tomography angiography (CTA) demonstrated a mural thrombus in the thoracic aorta and occlusion of the left brachial artery. The patient received intravenous recombinant tissue plasminogen activator (rTPA), followed by successful mechanical thrombectomy of the basilar artery. She was managed with systemic anticoagulation and discharged neurologically intact. This case highlights the critical importance of maintaining anticoagulation in high-risk individuals and demonstrates the potentially life-threatening consequences of abrupt discontinuation.